Attention deficit hyperactivity disorder(ADHD), this term has become infamous especially amongst middle aged mothers who have young children or toddlers going to kindergarten, play school. I have come across many mothers in their late 30s who are obsessed by their child’s hyper irritability and over activity, and the frequent complaints they hear from the wards’ schools. Of course, having sympathy about such mothers on one hand (because they ought to have the stamina and patience to control these over active children); I also want to put forth a word of caution that not all over/hyper activity can be termed as ADHD. This is where the parents as well as the school staff have to pay heed.
Clinically ADHD is characterized by inconsistent development coupled with chronic levels of inattention, impulsiveness and hyperactivity (scahill 2000) Also the rates of ADHD is 3 times higher in boys than girls. Though there is strong evidence of genetic factors influencing the expression of ADHD, we cannot deny that psycho social, environmental and cultural factors also have a bearing on the same. There is no independent diagnostic tests for ADHD, thus leaving us to rely on clinical symptoms largely. As mentioned, short durations of hyperactivity, impulsivity by the child should not be thought of as ADHD by parents or teachers. Chronic and persistent patterns of inattention and/or hyperactivity-impulsivity severe than in an individual of same age and/or development (early development usually at the age of 6-7years is taken as criteria to diagnose ADHD), which cannot be associated by any other mental disorders)is classified as ADHD. There is elaborate literature on research studies pertaining to the diagnosis, classification, treatment with different modalities and prognosis.
It is unfortunate to know that a variable degree of stigma presents in parents about the acceptability of their child to be impaired by ADHD or hyperkinetic disorder(terminology used internationally). Never the less caution is must about false positive identification of ADHDs in pre-school kids. Initially much experience and time is required to be invested in the diagnosis and confirmation of ADHD. Then only we can think of treating it. Usually children with ADHD have pronounced impairments in their academics as well as socio-emotional development.
Similarly variety of treatment options exist for ADHD ranging from psycho stimulant drugs to mantra meditation, counselling, Yoga & Mindfulness based cognitive therapy. Complementary therapies like Yoga and Mindfulness based stress reduction (MBSR) and so on are among the top 10 therapies practiced in the west for treating children and adolescents. Yoga is an ancient Indian science which is the oldest preventive and wellness treatise known. The more popular Astanga Yoga of Patanjali Maharshi proposes 8 principles viz., Yama, Niyama, Asana, Pranayama, Pratyahara, Dharana, Dhyana, Samadhi. The latter four constituting the Antaranga Yoga serve as step-wise guide for practicing meditation.
The epidemiological prevalence of ADHD ranges from 1.7% to as high as 16% and the symptoms can evolve with age presenting as signs of increased motor activity in adolescents. The same can be passed on to adulthood who find it difficult to participate in any sedentary jobs. In general, for diagnostic purpose early presentation before the age of 6 and impairment due to symptoms at least in 2 settings like home and school is mandatory.
The treatment of ADHD can be considered under three sub sections: Parent or family focused strategies, child focused and school-based interventions. There is a paradigm shift in the attitudes of parents who opt for holistic and alternative forms of treatment individually or in adjunct to pharmacological therapies. Of these Yoga and meditation are important forms of holistic therapies which aim in healing ADHD by acting on all the above mentioned sub sections.
Read: Introduction to ADHD
The Ashtanga yoga which is a time tested science helps to gradually bring the symptoms of ADHD under control, by creating awareness and insight in the child. The eight limbs of Ashtanga yoga progressing from the gross body to the subtle helps the practitioner to gain control over his/her body. This method comprises of postures/Asanas and antaranga yoga along with chanting of specific mantras provides remarkable effects in reducing the hyper activity and improving the attention span in ADHD children.
The prime symptoms of ADHD are hyperactivity, impulsivity, acting before thinking, impatience, restlessness leading to poor organizational skills making the child look clumsy; tax the nervous system of the child. Mind is usually equated to monkey due to its inborn tendency to wander. This normal tendency of mind is more pronounced in ADHD children. Yoga advocates that mind and prana are intricately linked and on controlling the prana, mind will relax by itself. This is evident from the verse 2, chapter 2 of Hatha yoga pradipika which states:
Chale vaate chalam chittam nischale nischalam bhaveth I
Yogi stanutvamaapnoti tato vayum nirodhayeth II
This means when prana moves the mental force/chitta also moves; when prana is without movement, chitta is also without movement. By this (Pranayama) the yogi(practitioner) attains steadiness and can restrain vayu. According to sage Patanjali, renowned as the Father of yoga, pranayama is the practice of controlled inspiration and expiration, ought to be practsed as per the instructions of the Guru. With regular practice as per instructions, balance and control over prana is established which helps in curtailing of mental agitation.
Bhagavadgita, popular hindu scripture quotes “Yogah karmasu kaushalam” which proves the fact that Yoga is the science of skill full action. The process is relaxed awareness and outcome being effectiveness which is helpful to treat the symptoms and heal the child internally. Often the child diagnosed of ADHD has difficulty in learning at school though they mostly have average or above average intelligence leading to lower self-confidence and self-esteem. Also it is seen that the parents being anxious about the performance of the child put pressure to improve their grades and performance by various means. The parents have to understand that development is a gradual process and any therapy which is a science cannot be deemed as a quick fix. Yoga helps to gain control of the body, balance the vital energy (prana) and calm the mind with internal awareness.
Meditation is said to have originated in India about 3000 years ago and has proved to be considerably effective in ADHD and many other psychological conditions. According to Davis (1998) Meditation is a set of attentional practices leading to an altered state or trait of consciousness characterized by expanded awareness and integrated self. There are different meditation types viz., Insight meditation, Mindfulness meditation, Vipasana, Qigong, Anapanasathi, Zen, Chun Do Sup Bup.
Anciently meditation has been associated with religious and spiritual terms. This provides the foundation for their evolution and development. Practically this should not deter modern day application by compartmentalizing and restricting its usage to specific sects or groups. It is a time tested developed knowledge which had been proved to be effective, as explained in ancient Yogic treatises. However, modern day organizations are using less spiritual and mystic terms in imparting this magnificent knowledge for the benefit of humanity globally.
Read: Introduction to ADHD
The modern meditational methods like Concentrative meditation which includes Transcendental meditation and Relaxation response widely practiced in the west as well as the Mindfulness meditation which emphasizes on opening awareness of the individual to the emerging contents of the mind; all are based on the principles of Yoga. The Dharana(Focusing), Dhyana(De-focusing meditation) and Samadhi(super-consciousness) similar to transcending consciousness have been propounded thousands of years ago. The wandering mind which in its grossest form preoccupied by random thoughts is brought to concentration by focusing on objects, colours, light or pleasant ideas is then focused in Dharana; after much practice it can ascend to Dhyana which is the actual meditation state, akin to mindfulness state where mind is trained to decondition its previous patterns of reaction to different forms of stimuli. As one attains this state and can sustain here for prolonged durations he can progress to the final eighth limb of Ashtanga yoga, Samadhi state analogous to Transcendentalism.
Yoga being the union of two poles of energy within an individual; aims at balancing and achieving homeostasis by Union rather than partition. Just as excess fat accumulates and blocks blood flow in the vessels, so does impurities from wrong life style clog the flow of energy/prana in the nadis which result in decreased energy manifestations. Yoga tries to make changes in the subtle energy field at pranic levels, so as to correct the gross manifestations in the body as ailments. Influxes of the mind can be controlled by pranic restraint and vice versa has been verified centuries ago. We have to only practice these deep-rooted strategies with immaculate faith to attain disease free, healthier, and blissful lives.
However, attention is to be taken in practicing this under strict observance of instructions by the Guru, failing which there is risk of release of kundalini energy in the blocked nadis leading to adverse effects.